Basic Information
| Provider Information | |||||||||
| NPI: | 1083048151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AINSWORTH SURGICAL PAVILLION, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6010 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101506010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122032813 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 E 57TH ST | ||||||||
| Address2: | 1210 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100222049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122032813 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2013 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUNTER | ||||||||
| AuthorizedOfficialFirstName: | COREY | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2122032813 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.